Nicotinic acid: contraindications and side effects. Nicotinic acid: indications for use, side effects, price

Nicotinic acid is a vitamin medicine. Most often this substance is referred to as vitamin B3 or PP. Therapeutic Use The product helps improve metabolic processes, restore normal blood circulation and dramatically reduce the level of lipoproteins, triglycerides and cholesterol. Nicotinic acid plays one of the most important roles in the prevention of a number of pathologies of cardio-vascular system. This substance also has a strong detoxifying effect. Due to the presence of a number of serious contraindications to the use of the medication, it is necessary to take nicotinic acid only as prescribed by the attending physician or other medical specialist.

Dosage form

Vitamin PP or a nicotinic acid Available in several dosage forms:

• crystalline powder white without a specific odor with a slightly sour taste;
• pills;
• ampoules with solution for parenteral administration.

Each form of the drug has certain characteristics therapeutic action, which makes it possible to use nicotinic acid against a wide range of diseases.

Description and composition

Nicotinic acid is a preparation of vitamin nature. The active component of the drug is 3-pyridinecarboxylic acid. pharmachologic effect and the structure of the substance is comparable to nicotinamide.

Composition per ampoule:

• 3-pyridinecarboxylic acid (nicotinic acid) – 10 mg;
• auxiliary elements: sodium bicarbonate, water for injection.

Composition per tablet:

• 3-pyridinecarboxylic acid (nicotinic acid) – 50 mg;
• auxiliary elements: stearic acid, glucose.

Pharmacological group

Nicotinic or 3-pyridinecarboxylic acid belongs to the group of vitamin metabolism regulators. Most often this substance is called vitamin PP or B3. When ingested, nicotinic acid takes on the form of nicotinamide, which takes part in the metabolism of proteins and fats, and also promotes tissue respiration and the conversion of glycogen into glucose (glycogenolysis). Taking therapeutic doses of the drug helps reduce the concentration of low-density lipoproteins, cholesterol and triglycerides in the blood plasma. In parallel, when nicotinic acid is consumed, an increase in lipoproteins is observed high density. Has an antiatherosclerotic effect.

This medication effectively eliminates the symptoms and consequences of intoxication of the body (including after overuse alcohol or drugs).

The product has a specific antipellargic effect, which consists in replenishing the deficiency of vitamin PP. Nicotinic acid also helps improve blood microcirculation in small vessels due to their expansion. It is a weak anticoagulant and reduces the level of thyroid-stimulating hormone.

After a few days of taking the medicine, a significant decrease in cholesterol levels in the blood is observed.

Indications

Medicinal products in which nicotinic acid is the active component have a fairly wide range of therapeutic applications. The substance can be used both as a medicine and for the treatment of a number of pathologies.

for adults

The main indications for which nicotinic acid is prescribed for therapy are the following conditions:

• atherosclerosis;
• vitamin PP deficiency (pellagra);
• ischemic cerebral stroke;
• circulatory disorders in the lower extremities;
• osteocondritis of the spine;
• haemorrhoids;
• liver dysfunction;
• various types of poisoning;
• deterioration of visual perception;
• lactose intolerance;
• obesity;
• ulcers on the legs of a trophic nature.

Preventive intake of nicotinic acid has the following goals:

• reducing the likelihood of cancer formation;
• elimination of hemorrhoid symptoms;
• improvement of visual acuity;
• losing weight by accelerating lipid metabolism;
• increased brain activity.

for children

Nicotinic acid tablets can be used as a preventive and medicinal product for children of all ages. However, taking the medication must be accompanied by the supervision of the attending physician due to the lack of reliable information about the safety of use. Injection form The use of medication is not recommended.

The range of pathologies for which it is advisable to use nicotinic acid in children coincides with the indications for adult patients.

The use of nicotinic acid during pregnancy and during breastfeeding It is recommended to carry out with extreme caution and only under the strict supervision of a specialist. The therapeutic use of 3-pyridinecarboxylic acid is justified only when the probable benefit to the woman outweighs the danger.

Contraindications

Despite the fairly wide range medicinal influence, taking nicotinic acid is completely contraindicated for some patients. The main conditions in which the use of the drug is prohibited are:

• ulcerative lesions duodenum or stomach in the acute stage;
• gout;
• severe form of arterial hypertension;
• liver failure and others functional disorders in liver function;
• hypersensitivity or absolute intolerance to the elements of the medication;
• pathologically high concentration uric acid in blood plasma (hyperuricemia);
• atherosclerosis in severe form (use of intravenous injections nicotinic acid).

Caution should be exercised in conditions such as:

• gastritis with high level acidity;
• glaucoma;
• hepatitis;
• hemorrhagic syndrome;
• cirrhosis of the liver;
• period of pregnancy and breastfeeding;
• ulcerative lesions of the duodenum or stomach in remission.

Applications and dosages

The dosage and regimen of therapeutic and prophylactic use of nicotinic acid is determined exclusively by a specialist. To do this, it is necessary to know the nature of the pathology and Current state the patient's body. Self-use of the drug can worsen the disease and increase the risk of complications.

For parenteral injections, 1%, 2.5% or 5% solutions of the drug are used.

Nicotinic acid in tablet form should be taken after meals with a sufficient amount of clean water.

for adults

When treating vitamin PP deficiency (pellagra), intravenous (50 mg) or intramuscular (100 mg) administration of nicotinic acid is recommended 1-2 times a day. The treatment period can range from ten to fifteen days.

For the treatment of ischemic stroke, the solution is administered intravenously at 100–500 mg.

In all other cases, as well as when treating children under 18 years of age, it is recommended to use only the tablet form of the medicine.

Preventive intake of nicotinic acid tablets for pellagra is 12.5–25 mg per day. Therapeutic dose – 100 mg three or four times a day for 14–20 days.

For the treatment of atherosclerosis, high dosages of the drug are prescribed, ranging from 2000 to 3000 mg per day.

In the case of prevention of pathologies of the cardiovascular system, the use of 500–1000 mg of medication per day is justified.

For the treatment of other diseases, an individual dosage is calculated.

for children

Children are allowed to use only the tablet form of nicotinic acid.

The dosage of the drug for other diseases is determined exclusively by the pediatrician.

for pregnant women and during lactation

Side effects

Most common side effects after consuming nicotinic acid are:

• intestinal disorder;
• flatulence;
• nausea and seizures;
• dizziness;
• belching and heartburn;
• hypotension;
• liver dysfunction;
• decreased glucose tolerance;
• ulcerative lesions of the gastric mucosa;
• skin rashes and itching;
• feeling of powerlessness (asthenia);
• fatty liver;
• increased levels of glucose and uric acid in the blood;
• arrhythmia;
• redness and tingling of the skin of the face and neck.

Interaction with other drugs

The drug enhances the effects of antihypertensive medications and anticoagulants.

Nicotinic acid reduces the toxic effects of neomycin.

special instructions

With long-term use of the drug, it is necessary to monitor the functioning of the liver. To reduce the risk of developing ulcerative lesions stomach or duodenum, it is recommended to take nicotinic acid tablets with milk.

Nicotinic acid does not affect the reaction rate, adequate perception reality and the quality of cognitive functions, therefore, throughout the entire course of use, it is allowed to drive vehicles, engage in dangerous sports and work with precision and unsafe mechanical devices.

Overdose

An overdose of nicotinic acid is characterized by increased side effects. If negative effects are detected after taking a high dose medication contact a medical facility.

Storage conditions

The medication should be stored in a dry, dark place at a temperature of 20 to 25 degrees. Keep children away from this medicine.

Shelf life – 4 years.

Analogs

Instead of nicotinic acid, you can use the following medications:

1. Enduracin contains nicotinic acid as an active component. It is produced in long-acting tablets, which are contraindicated for minors, pregnant and lactating women.
2. Velmen is a vitamin and mineral complex that contains nicotinic acid. It is produced in capsules, which can only be drunk by persons over 18 years of age.
3. Gitagamp - domestic multivitamins containing nicotinic acid. It is produced in capsules, which are not suitable for children, pregnant patients, or during lactation.
4. Pregnakea is a vitamin and mineral complex that is produced in capsules. They are recommended for women planning to conceive, carrying a child and breastfeeding.

Drug price

The cost of the medicine is on average 39 rubles. Prices range from 11 to 191 rubles.

The functioning of all cells, tissues, organs and systems of our body directly depends on sufficient intake of various kinds nutritional elements. A lack of certain particles can provoke disturbances of various kinds - both minor and very serious. In addition, nutritional elements - vitamins, acids and minerals - in some cases can be used as a therapeutic agent, helping to eliminate various pathological conditions. It is precisely these qualities that nicotinic acid has, the instructions for use of which will interest us today. It can be purchased at almost any pharmacy; the medicine comes with a detailed leaflet that describes its use, indications and contraindications for treatment with its use, the effect of the drug, possible side effects, as well as analogues, composition and dosage.

What is the composition of the drug “Nicotinic acid”?

Nicotinic acid is available in the form of powder, tablets and solution for injection.
Each tablet of the drug is a source of 0.05 g of the active substance, as well as some auxiliary components - glucose and stearic acid. In addition to nicotinic acid, the ampoules also contain an injection solution.

What is the effect of Nicotinic Acid?

Nicotinic acid is a specific antipellargic agent. It has pronounced short-term vasodilating properties, optimizes carbohydrate and nitrogen metabolism. In addition, this substance is characterized by hypolipidemic properties; it can reduce the amount total cholesterol in the body, as well as low-density lipoprodeids and triglyceride particles.

The use of nicotinic acid helps increase the level of high-density lipoproteins and improve microcirculation processes. This substance, after being processed by the body, still takes part in the metabolic processes of fats, proteins, protein and purines; it is necessary for full tissue respiration, glycogenolysis and synthetic processes. The use of nicotinic acid allows you to compensate for the lack of vitamin PP. This element also has vasodilating properties at the level of small vessels, optimizes microcirculation processes, and is characterized by weak anticoagulant properties.

What are the indications for use of the drug "Nicotinic acid"?

In most cases, nicotinic acid is used to treat hypovitaminosis of vitamin PP or vitamin deficiency of this substance, similar condition accompanied by the development of a disease such as pellagra.

In addition, nicotinic acid can be used as a component combination treatment, for example, in the correction of ischemic stroke, neuritis facial nerve, obliterating diseases of the vessels of the extremities, which include obliterating endarteritis, as well as Raynaud's disease. Also, such a drug can help patients with diabetes, including its complications, including diabetic polyneuropathy and microangiopathy.

The use of nicotinic acid is advisable in the treatment of Hartnup's disease, the so-called hereditary disease in which the normal absorption of many amino acids is disrupted.

What is the use and dosage of the drug “Nicotinic acid”?

For preventive purposes, the drug is taken at 0.015 g; children should consume 0.005 g per day.
For the treatment of pellagra, it is customary to use a dosage of 0.1 g for adults two to four times a day; children are prescribed a dosage of 0.005-0.05 g two to three times a day.

For other ailments, adults take the drug at 0.02-0.05 g, and children at 0.005-0.03 g.
The maximum daily dose for adults is considered to be 0.5 g of the active substance; for oral consumption, this volume can be increased over time to 1 g.

What are the side effects of the drug Nicotinic Acid?

The use of nicotinic acid in rare cases can cause various side effects, including a feeling of a rush of blood to the scalp area, noticeable redness of the skin on the face and on the upper half of the body. Sometimes this drug causes orthostatic hypotension, fever, headaches and collapse. Fast intravenous administration medication is fraught sharp decline blood pressure and the development of dizziness.

Nicotinic acid can also provoke paresthesia and dizziness, it long-term use rarely causes fatty liver disease. Also, long-term therapy with such a composition can cause hyperucricemia, decreased glucose tolerance, asthenia and an increase in the blood levels of a number of indicators (AST, ALP and LDH).

Carrying out subcutaneous and intramuscular injections provokes development painful sensations.
Among other things, the drug can cause various allergic reactions.

What are the contraindications for use of Nicotinic Acid?

Intravenous administration of nicotinic acid cannot be carried out in severe forms of hypertension or atherosclerosis. The drug should not be used when hypersensitivity. To prevent the development of fatty liver disease, patients are advised to eat more products with methionine or take this amino acid in the form of drugs.

What are the analogues of the drug “Nicotinic acid”?

A number of medications have a similar composition and effect, including Apelagrin, Vitamin B3, Vitamin PP, as well as Niacin, Liplit, Nicodone, Nicotene, etc. Before replacing your prescribed drug with an analogue, be sure to consult your doctor.

Nicotinic acid and its derivatives - nicotinamide, niketamide - form a group of water-soluble PP vitamins. These chemically and biologically related compounds are easily converted into each other in the body, and therefore have the same vitamin activity. Other names for nicotinic acid are niacin (obsolete name), vitamin PP (antipellagric), nicotinamide.

IN clinical practice nicotinic acid and nicotinamide are used as medicines. However, the pharmacotherapeutic properties of these drugs are different.
Nicotinic acid has the following effects:

• vasodilating effect (“inflammation effect”), cardiotrophic, increases blood microcirculation;
• has an anticholesterolemic effect - reduces the breakdown of fats;
• has a hepatoprotective and detoxifying effect, but in high doses with long-term use nicotinic acid causes fatty liver degeneration;
• is a neurotropic drug;
• improves the functioning of the heart and blood vessels.

Nicotinic acid has a beneficial effect on fat metabolism, reduces cholesterol in the blood of patients with atherosclerosis, expands blood vessels(when taking doses over 75 mg), helps with dizziness, eliminates ringing in the ears.

Nicotinic acid preparations are used to prevent and treat pellagra, neuritis, hepatitis, chronic vascular disease with predominant damage to the arteries of the legs (endarteritis).

Nicotinic acid prevents heart attacks, reduces depressive states, facilitates headache, improves performance digestive tract. It has a positive effect on mild forms of diabetes mellitus, gastric and duodenal ulcers, enterocolitis, sluggishly healing ulcers and wounds, and infectious diseases.

The role of nicotinic acid in biological processes

The biological role of nicotinic acid is associated with its participation in the construction of two coenzymes - NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate), which are part of the most important redox enzymes. Coenzymes (coenzymes) are organic natural compounds necessary for the catalytic action of enzymes. Coenzymes function as carriers of electrons and atoms from one substrate to another.

Vitamin PP attaches to proteins and together with them creates several hundred various enzymes. Nicotinic acid enzymes form a “bridge” through which hydrogen atoms are sent into the “furnace”. Trillions of "furnaces" are fired up in the body's cells and help release energy from carbohydrates, fats and proteins in food.

Nicotinic acid is directly involved in the processes of biological oxidation and energy metabolism. As a component of NAD and NADP, it promotes the release of energy from food, DNA synthesis, and regulates cellular respiration processes.
Nicotinic acid is involved in the following biological processes:

• cellular respiration, cellular energy;
• circulation;
• carbohydrate, fat, protein metabolism;
• mood;
• cardiac activity;
• cholesterol control;
• muscles;
• connective tissue;
• production of gastric juice;
• functions of the digestive tract.

Nicotinic acid increases utilization in the body vegetable proteins, normalizes the secretory and motor function of the stomach, improves the secretion and composition of pancreatic juice, and normalizes liver function.

Almost all available in cells and liquid media The body contains nicotinic acid in the form of nicotinamide.

Products containing niacin

The main natural source of nicotinic acid in the human body are products of animal origin:

• animal organs - liver, kidneys, muscles, heart;
• some types of fish - sardine, mackerel, tuna, salmon, halibut, swordfish, cod.

Cereal grains and bread are rich in nicotinic acid coarse, rice and wheat bran, dried apricots, mushrooms, almonds, green peas, tomatoes, red sweet peppers, potatoes, soybeans. An excellent source of replenishing the lack of nicotinic acid is baker's yeast and brewer's yeast.

Table 1 shows the products that contain the greatest amount of nicotinic acid.
Table 1

The vitamin value of products depends not only on the amount of nicotinic acid, but also on the forms in which it exists. Thus, in legumes it is in an easily digestible form, but in grains (rye, wheat) the vitamin is practically not absorbed.

In animal tissues, nicotinic acid is mainly found in the form of nicotinamide, in plants - as nicotinic acid. Vitamin PP is absorbed into small intestine and is consumed by the body.

Nicotinic acid is one of the most resistant vitamins in terms of storage, cooking, and preservation. Heat when boiling and frying, it has almost no effect on its content in the product. Vitamin PP is also resistant to light, oxygen, and alkalis. It practically does not lose biological activity when freezing and drying products. For any treatment total loss nicotinic acid does not exceed 15 - 20%.

Nicotinic acid can be partially synthesized from the essential amino acid tryptophan. However, this process is ineffective - only one vitamin molecule is formed from dozens of tryptophan molecules. However, foods rich in tryptophan (milk, eggs) can compensate for insufficient dietary intake of nicotinamide.

Daily vitamin requirement

Children and adolescents need nicotinic acid daily:

• 5 – 6 mg up to one year of age;
• 10 – 13 mg for children from 1 year to 6 years;
• 15 – 19 mg at the age of 7 to 12 years;
• 20 mg for adolescents 13 to 15 years old.

Adults need about 6.6 mg of the vitamin for every 1,000 calories consumed. That is daily requirement in nicotinic acid for adults is 15 – 25 mg.
An increased need for vitamin PP is needed:

• those who engage in heavy physical labor;
• elderly people;
• patients who have recently suffered severe injuries and burns;
• persons who use alcohol and drugs;
• people suffering from debilitating chronic diseases, including malignant tumors, pancreatic insufficiency, cirrhosis, sprue;
• with nervous overstrain;
• young children born with metabolic disorders (congenital disorders caused by abnormalities in the chromosome set);
• pregnant and lactating women.

Excessive consumption of sugar, sweets, and sweet drinks leads to loss of nicotinic acid. Nicotine reduces the absorption of vitamin PP. Therefore, people who are addicted to nicotine may also need additional nicotine supplementation.

Long-term use of large doses of leucine can lead to a deficiency of tryptophan and niacin.

Hypovitaminosis and hypervitaminosis

With insufficient intake of nicotinic acid in the body, a person develops the following early symptoms of hypovitaminosis: general fatigue, lethargy, apathy, decreased performance, insomnia, loss of appetite, weight loss, headaches, disorders of consciousness, weakened memory, indigestion, irritability, depression.

Secondary nicotinic acid deficiency occurs in a number of diseases gastrointestinal tract, neuritis, allergic dermatoses, poisoning with lead, benzene, thallium.

Late symptoms of acid deficiency are pellagra disease.

It was not possible to induce a state of hypervitaminosis (ultra-high doses of vitamin PP) in mammals. Nicotinic acid reserves do not accumulate in tissues. Its excess is immediately excreted in the urine. Increased content nicotinic acid may be accompanied an unpleasant feeling"skin heat"

Diagnostics of the body's supply of nicotinic acid

An indicator of the supply of vitamin PP to the human body is the excretion in urine of the main metabolic products of nicotinic acid - N-methylnicotinamide and methyl-2-pyridone-5-carboxyamide. Normally, 7–12 mg is excreted in urine per day.

A decrease in the level of acid excretion in urine indicates an insufficient supply of vitamin PP to the body and the possibility of developing vitamin deficiency. The concentration of metabolites of nicotinic acid and nicotinamide increases sharply when they enter the body in excess.

Of particular value is the study of the quantitative content of N-methylnicotinamide after loading with nicotinic acid or nicotinamide. This is the only criterion for determining the body’s supply of this vitamin. The level of vitamin PP itself or its coenzyme forms in the blood cannot be decisive, since even with severe pellagra their content differs little from that in healthy individuals.

Laboratory tests to detect niacin deficiency are urine test #1 for methylnicatinamide and urine test 2-pyridone/#1 for methylnicatinamide.

Test results are not always conclusive.

Chemical methods for the quantitative content of nicotinic acid include the reaction of determining nicotinic acid with bromine cyanide.

Nicotinic acid and nicotinamide for cardiovascular diseases

One of the main causes of cell damage and death during oxygen starvation (acute ischemia) is the developing insufficiency of energy supply. It is associated both with increased energy consumption (operation of detoxification systems, activation of transport adenosine triphosphates) and with insufficient formation of biological molecules that are able to accumulate and transfer energy during the reaction due to damage to mitochondrial membranes and other things.

The concentration of substances involved in energy metabolic processes changes dramatically. During ischemia in the brain, a cascade of physiological and pathophysiological reactions develops at the molecular level:

1. Blood supply to the brain decreases. Accordingly, the delivery of oxygen from the bloodstream to the cells decreases. And since oxygen participates in energy production reactions, oxygen starvation develops - a hypoxic state. The cell loses the ability to oxidize a number of energy substrates.
2. Rise oxygen deficiency is accompanied by a decrease in the content of adenosine triphosphate (ATP), an energy source.
3. In the final stages oxygen starvation the level of energy deficiency becomes sufficient to trigger the main mechanisms leading to disruption of vital functions and cell death.
4. The concentration of adenosine monophosphate (AMP) increases rapidly. And this is an additional mechanism for the destruction of cell membranes.
5. Disorders of energy metabolism develop rapidly. This leads to necrotic cell death.
6. A change in the state of membrane structures and receptors triggers a single molecular mechanism aimed at the response of brain tissue to a damaging effect. An acute decrease in cerebral blood flow (cerebral ischemia) activates a complex of genetic programs that lead to the sequential transformation of hereditary information large number genes.
7. The first reaction of brain tissue to a decrease in cerebral blood flow is a decrease in the synthesis of messenger RNA and proteins - the poly(ADP-ribosyl)ation reaction - modification of proteins. This reaction involves the enzyme poly(ADP-ribose) polymerase (PARP).
8. The donor of ADP-ribose is nicotinamide dinucleotide (NAD). The enzyme poly(ADP-ribose) polymerase (PARP) begins to very actively (500 times stronger) consume nicotinamide, greatly reducing its content inside the cell. And since nicotinamide dinucleotide regulates vital processes in the cell, its deficiency causes cell death through necrosis.

The use of drug protection of the brain reduces the risk of developing cerebral ischemia during a period of temporary cessation of blood flow through the supporting vessel. For this purpose, drugs are used that inhibit (inhibit) the activity of the cellular enzyme poly(ADP-ribose) polymerase. Averted sharp drop nicotinamide levels, cell survival increases. This reduces tissue damage associated with ischemic stroke and myocardial infarction.

Active inhibitors (substances that suppress the course of enzymatic processes) include nicotinamide. In structure and action, it is close to nicotinic acid and participates in redox processes in the body. Nicotinamide has a high selective effect on the enzyme poly(ADP-ribose) polymerase. It also has a number of non-specific effects:

• acts as an antioxidant;
• affects metabolic processes glucose, lipids and nucleotides;
• suppresses the general synthesis of DNA, RNA and protein.

Nicotinamide prevents the development of severe metabolic disorders in the brain, activates the energy metabolism systems in the cell, helping to maintain the energy status of the cell.

Combined preparations containing nicotinic acid are widely used for disorders cerebral circulation, myocardial infarction, obliterating endarteritis, Raynaud's disease, that is, in all cases where increased microcirculation and collateral (bypass) circulation is actually the only way to preserve the functional abilities of tissues.

Experimental and clinical data show that vitamin PP relaxes spasmodic coronary vessels, therefore, for angina pectoris, nicotinic acid is successfully used in the preparations Nikoverin and Nikoshpan.

By activating specific enzymes - tissue fibrinases, nicotinic acid increases the activity of the blood to dissolve intravascular blood clots.

Nicotinic acid reduces blood cholesterol levels

One of the preventive measures associated with acute cerebrovascular accidents is reducing blood cholesterol levels. Nicotinic acid prevents the release of fatty acids and thus reduces cholesterol levels in the blood.

Nicotinic acid has been used as a lipid-lowering agent since 1955. IN high dose it has a diverse effect on lipid metabolism:

• inhibits the breakdown of fats in adipose tissue, which limits the delivery of free fatty acids to the liver, ultimately inhibiting the hepatic synthesis of triglycerides and very low density lipoproteins (VLDL);
• increases the breakdown of VLDL in the blood;
• reduces the content of low-density lipoproteins (LDL) in the blood, depleting their precursors - very low-density lipoproteins;
• increases the level of high density lipoproteins (HDL).

Nicotinic acid in doses of 3 - 6 g per day reduces the amount of cholesterol, low-density lipoproteins by 15 - 25% after 3 - 5 weeks of therapy, reduces the level of triglycerides (fat molecules) of very low-density lipoproteins by 20 - 80% after 1 - 4 days , increases the content of high-density lipoprotein cholesterol by 10 - 20%, prevents the appearance of lipoprotein (a).

Patients tolerate nicotinic acid much better when it is used in dosage forms with a prolonged action. These are Nicobid Tempules (microencapsulated tablets with fast and slow release), Slo-Niacin (a combination of nicotinic acid with polygel), Enduracin (tropical wax matrices containing nicotinic acid).

Taking nicotinic acid alone in a daily dose of 3 g or in combination with other drugs leads to a reduction in the incidence of non-fatal myocardial infarction, strokes, and the need for surgical intervention on the heart and blood vessels. Patients receiving niacin show signs of regression coronary atherosclerosis, reducing the incidence of progression of atherosclerotic lesions.

Cardiotrophic effect of nicotinic acid

With repeated use of nicotinic acid in the damaged myocardium, the content of pyruvic and lactic acids decreases, while the content of glycogen and adenosine triphosphate increases.

Improving microcirculation due to the expansion of capillaries increases the enrichment of myocardial oxygen. As a result of the normalization of biochemical processes, the contractile activity of the myocardium also improves (cardiotonic effect of nicotinic acid).

Nicotinic acid potentiates the effect medicines plant origin, providing cardiotonic and antiarrhythmic effect– cardiac glycosides. The drugs are used to treat heart failure. The use of nicotinic acid in combination with digitalis glycosides is especially effective.

Hepatotropic effect of vitamin PP

Nicotinic acid affects liver function. The hepatotropic effect is expressed in stimulation of the secretion and release of bile, stimulation of glycogen-forming and protein-forming functions of the liver.
Nicotinic acid is indicated:

• for various intoxications professional nature– poisoning with aniline, benzene, carbon tetrachloride, hydrazine;
• in case of household poisoning;
• with drug intoxication with barbiturates, anti-tuberculosis drugs, sulfonamides;
• for toxic hepatitis.

Under the influence of nicotinic acid, the detoxification ability of the liver increases - the formation of paired glucuronic acids, formed during the detoxification process, increases; Toxic metabolic products and external toxic compounds are replaced.

Neurotropic effect of nicotinic acid

Neurotropic drugs are drugs that have an effect on the central and peripheral nervous system. Nicotinic acid is involved in the biosynthesis of hormones that affect the human psyche.

The “happiness hormone” serotonin is formed from tryptophan. Serotonin affects a person's sleep and mood. Since nicotinic acid is absolutely indispensable for the production of energy in the cells of the body, when it is deficient, a significant proportion of tryptophan is converted into nicotinic acid. The more tryptophan is used for energy, the less is available to calm the nerves and good night. A lack of serotonin leads to insomnia, poor concentration, depression, nervousness, even depression, hallucinations, and sometimes schizophrenia.

Nicotinic acid is the only vitamin that is indirectly involved in hormonal metabolism in the human body. Its neurotropic properties are manifested by increased inhibitory processes. Strengthening inhibitory processes under the influence of nicotinic acid has a beneficial effect on the body as a whole: efficiency increases, the number of inappropriate reactions decreases.

Nicotinic acid is used in the treatment of neurotic and psychotic conditions, alcoholic delirium (disorder of consciousness), chronic alcoholism. It potentiates the effect of neuroleptics and barbiturates, weakens the effect of caffeine and phenamine.

Nicotinamide is a mixed-action drug with wide range applications. It is part of the drug Cytoflavin. This is a balanced complex of components, an effective combination of which has a synergistic regulatory effect on all major metabolic pathways in the central nervous system, which are impaired to one degree or another during cerebral ischemia.

Cytoflavin reduces the degree of neurological deficit and accelerates functional recovery in ischemic stroke. The drug affects the main pathophysiological processes that occur during ischemic damage neuronal structures of the brain:

• restores antioxidant protection factors;
• activates energy-generating processes and reactions;
• inhibits oxidative stress reactions, increasing the ability of cells to utilize glucose and oxygen;
• stimulates protein synthesis inside cells.

Thanks to these numerous effects, coronary and cerebral blood flow improves and metabolic activity in cells is stabilized central system, which is clinically manifested by a decrease in the existing neurological deficit and restoration of impaired functions.

Nicotinamide is part of the combined metabolic drug Cocarnit (manufactured by World Medicine, UK). The drug is indicated for symptomatic treatment complications of diabetes mellitus – diabetic polyneuropathy.

Nicotinamide improves nerve conduction and blood flow in nerves in diabetes mellitus, reduces lipid oxidation, the formation of free radicals and secondary products of lipid oxidation. The drug has multiple effects and low toxicity at high doses in the treatment of patients, which is confirmed by the results of numerous studies.

Pellagra (niacin deficiency): symptoms and treatment

Pellagra (from the Italian pelle agra – rough skin) is a disease associated with insufficient intake or incomplete absorption of nicotinic acid into the body. The basis of the disease is a violation of the energy of cells and their ability to actively divide.

In the past, pellagra developed in areas where corn was the main food source. In this cereal crop nicotinic acid is contained in a form that is difficult to digest; it is poor in tryptophan, from which the vitamin can be synthesized. The main regions where pellagra occurred were southern Europe, Africa, Latin America, and the southern states of the USA. IN Tsarist Russia the disease occurred in Bessarabia (Moldova), and to a lesser extent in Georgia.

The main reason for the development of nicotinic acid deficiency in residents of our country is chronic diseases gastrointestinal tract (enteritis, colitis) associated with impaired absorption.

Causes of the disease

The cause of the disease is not only the low content of nicotinic acid in food products, but also:

• insufficient tryptophan content;
• high content of leucine in food, which inhibits the synthesis of the enzyme NADP in the body;
• low levels of pyridoxine enzymes;
• the presence in grain products of niacitin and niacinogen, as well as related forms of nicotinic acid that are not absorbed by the body.

In children, pellagra usually develops with an unbalanced diet with a predominance of carbohydrates. In very rare cases, the disease develops in breastfed children as a result of insufficient vitamin content in the diet of the nursing mother.

Pathological processes occurring during illness

Pellagra affects the skin, gastrointestinal tract and nervous system. The severity of the processes depends on the stage and form of the disease.
Changes skin appear in the form of large areas of red-brown color, overflowing with blood, with sharp boundaries of the lesion. The skin swells and thickens. On late stages The disease causes atrophy of the epidermis.

Erosion or ulcers appear in the oral cavity. A swollen, bright red tongue with painful ulcerations later becomes lacquered. Atrophic changes occur in the covering epithelium of the pharynx and esophagus, the mucous membrane of the small and large intestines.

The stomach, pancreas and liver decrease in size. The mucous membrane of the stomach is anemic, with isolated hemorrhages, the folds are weakly expressed. Secretion is suppressed digestive glands, ahilia arises - absence of hydrochloric acid and the enzyme pepsin in gastric juice. In the liver, fatty degeneration of its working hepatocyte cells is observed.

In the head and spinal cord, as well as in the peripheral nervous system, dystrophic changes in neurocytes with signs of neuronophagy are detected - damaged or degeneratively changed nerve cells are destroyed and removed from the body with the help of phagocytes - cells of the immune system.

Significant disturbances in the metabolism and functions of many organs lead to dystrophic and degenerative changes in almost all organs and tissues. The kidneys, lungs, heart, and spleen are affected.

Symptoms of pellagra

Pellagra occurs in school and adolescence, V early childhood- very rarely. Mostly adults aged 20–50 years get sick.
The clinical picture of pellagra is characterized by three main manifestations:

• dermatitis - skin lesions in symmetrical areas accessible to action sun rays(hence the name of the disease);
• – gastrointestinal disorder;
• – mental disorder with memory loss, dementia, delirium.

Signs of the disease usually appear towards the end of winter. Patients feel weak 3–5 times a day or more often. The stool is free of blood and mucus, watery, with a putrid odor.
Then there is a burning sensation in the mouth and severe salivation. Lips become swollen and cracked. Sores appear on the gums and under the tongue. Characteristic changes in language. Initially, its back is covered with a black-brown coating, the edges and tip are bright red. Gradually, the redness spreads to the entire surface of the tongue, it becomes smooth and shiny.
Then pellagritic erythema appears: in exposed areas (face, neck, back of the hands and feet), the skin becomes red, swollen and itchy when exposed to sunlight. Sometimes blisters form that burst and leave a weeping hole. After a few days, pityriasis-like peeling occurs. With a decrease in inflammatory phenomena, persistent grayish-brown pigmentation remains on the affected areas of the skin, and depigmentation such as vitiligo is less common.

The function of peripheral nerves and the central nervous system is impaired. Dizziness and headaches appear. Apathy gives way to depression. Psychoses and psychoneuroses develop; in severe cases, hallucinations occur, convulsions occur, and mental retardation develops.

In early childhood, the classic symptoms of pellagra are not so pronounced. Inflammation of the tongue, gastrointestinal disorders, and skin redness predominate. Mental changes are rare.

The most severe complication of pellagra is (organic brain damage) with psychotic reactions.

Diagnosis of the disease

Diagnosis is based on characteristic clinical manifestations diseases, data on nutritional patterns, biochemical studies. Pellagra is characterized by the content of NI-methylnicotinamide in daily urine below 4 mg, the content of nicotinic acid - below 0.2 mg. The content of other B vitamins in the blood and urine decreases.

Treatment

All patients with fresh and recurrent manifestations of pellagra are subject to hospitalization.

Treatment of patients with insufficient intake of nicotinic acid includes a diet, rich in vitamins PP containing sufficient quantity squirrel. For mild forms of vitamin deficiency, vitamins are prescribed in tablets. For patients suffering from insufficient absorption of nutrients in the small intestine, they are administered by injection.
The recommended daily dose for treatment is 300 mg of the vitamin, divided into 2 to 3 doses. Treatment continues for 3 to 4 weeks.

Therapeutic doses of nicotinic acid are preferably administered in the form of nicotinamide, which has significantly fewer side effects than the use of nicotinic acid.

At mental disorders low doses of antipsychotics (aminazine, frenolone, triftazine) are prescribed in combination with antidepressants (amitriptyline) and tranquilizers (seduxen), which are administered intramuscularly or intravenously. In cases of the development of organic psychosyndrome, high doses of thiamine or nootropil are prescribed in the form of repeated courses.

Since pellagra shows signs of deficiency of other B vitamins, as well as the amino acid tryptophan, the treatment plan includes the administration of a vitamin B complex preparation.

After starting treatment, symptoms of gastrointestinal distress disappear within a few days. Signs of dementia and dermatitis improve significantly during the first week of therapy. If pellagra has become chronic, recovery requires a longer period of treatment, but the patient's appetite and general physical condition quickly improve.

Prevention

A varied, balanced diet with sufficient dietary content of foods rich in nicotinic acid, fortification of corn flour and cereals, wheat flour premium and first grade nicotinic acid, health education of the population.

Secondary pellagra

Cases of pellagra have been described in patients suffering from organ diseases digestive system with anachlorhydria (lack of hydrochloric acid) with cancer of the esophagus, ulcers, cancer and syphilitic lesions of the stomach and duodenum, chronic ulcerative colitis, tuberculosis, after dysentery, after operations on the digestive system, with chronic alcoholism, treatment of tuberculosis with isoniazid.

Nicotinic acid preparations

In clinical practice, nicotinic acid itself and its derivatives are used - slow-release forms Niaspan and Enduracin. In the USA, a fixed combination of nicotinic acid and lovastine is used - Advicor. Sustained-release forms of niacin are better tolerated but have less lipid-lowering efficacy.

Nicotinic acid: instructions for use

pharmachologic effect

Nicotinic acid is a specific antipellagric agent (vitamin PP). She improves carbohydrate metabolism, has a vasodilating effect, including on the blood vessels of the brain, and has hypolipidemic activity. Nicotinic acid 3–4 g per day (large doses) reduces the content of triglycerides and low-density lipoproteins in the blood, reduces the cholesterol/phospholipids ratio in low-density lipoproteins. Has detoxifying properties.

Dosage forms

Nicotinic acid is available in the form of tablets and solution for injection.
Subcutaneous and intramuscular injections of the vitamin are painful. The intravenous solution must be administered slowly, as a strong decrease in blood pressure may occur.

Compound

One tablet contains: nicotinic acid 0.05 g – active ingredients; glucose, stearic acid – excipients.
One milliliter of solution for injection contains: nicotinic acid 10 mg – active substance; sodium bicarbonate, water for injection - excipients.

Indications

Prevention and treatment of pellagra (vitaminosis PP).

Complex therapy of ischemic disorders of cerebral circulation, obliterating diseases of the vessels of the extremities (obliterating endarteritis, Raynaud's disease) and kidneys, complications of diabetes mellitus - diabetic polyneuropathy, microangiopathy.

Liver diseases - acute and chronic hepatitis, gastritis with low acidity, neuritis of the facial nerve, various intoxications (professional, medicinal, alcoholic), long-term non-healing wounds and ulcers.

Contraindications

The drug is contraindicated in the following cases:

• hypersensitivity to the components of the drug;
• peptic ulcer of the stomach and duodenum in the acute stage;
• severe arterial hypertension;
• gout;
• hyperuricemia, nephrolithiasis, liver cirrhosis, decompensated diabetes mellitus;
• pregnancy and breastfeeding period.

Method of use of nicotinic acid and dosage

Used as prescribed by a doctor.
Nicotinic acid tablets are taken orally after meals.
The following is prescribed as an antipellagritic agent:

• adults - nicotinic acid 0.1 g 2 - 4 times a day (maximum daily dose - 0.5 g);
• children - from 0.0125 to 0.05 g 2 - 3 times a day, depending on age.

The course of treatment is 15–20 days.
For adults with ischemic cerebrovascular accidents, vascular spasms of the extremities, gastritis with low acidity, neuritis of the facial nerve, wounds and ulcers, it is recommended to prescribe nicotinic acid in a single dose of 0.05 - 0.1 g, in a daily dose - up to 0.5 g. Course treatment – ​​1 month.

Side effects

Possible allergic reactions, dizziness, redness of the face, a feeling of a rush to the head, paresthesia (a feeling of numbness, loss of sensitivity, crawling, tingling). In this case, you should reduce the dose or discontinue the drug.

With long-term use of nicotinic acid in large doses, the development of fatty liver degeneration, hyperuricemia, increased activity of liver transaminases and alkaline phosphatase, decreased glucose tolerance.

Overdose

Overdose is unlikely.
In persons with individual intolerance, nicotinic acid can cause redness of the face and upper half of the body, dizziness, a feeling of a rush of blood to the head, urticaria, and paresthesia. These phenomena go away on their own and do not require special treatment.

Therapy control, precautions

To prevent liver complications with long-term use of nicotinic acid in large doses, it is recommended to include foods rich in methionine (cottage cheese) in the diet or use methionine, lipoic acid, Essentiale and other lipotropic agents.

Nicotinic acid should be used with caution for gastritis with high acidity, gastric ulcer and duodenal ulcer. During treatment with the vitamin, especially in large doses, liver function should be carefully monitored.

Interaction with other drugs

Consultation with a doctor is necessary if nicotinic acid is used simultaneously with other medications.

Pharmaceutical incompatibility. Do not mix with thiamine chloride solution (thiamine is destroyed).

Potentiates the effect of fibrinolytic agents, antispasmodics and cardiac glycosides, enhances the toxic hepatotropic effect of alcohol.

Caution must be taken when combining with antihypertensive drugs(possibly amplification hypotensive effect), anticoagulants, acetylsalicylic acid due to the risk of hemorrhage.

Reduces the toxicity of neomycin and prevents the decrease in the concentration of cholesterol and high-density lipoproteins induced by it. Reduces the toxic effect of barbiturates, anti-tuberculosis drugs, sulfonamides.

Oral contraceptives and isoniazid slow the conversion of tryptophan to niacin and thus may increase the need for niacin.

Antibiotics may increase hyperemia caused by nicotinic acid.

Nicotinic acid is available without a doctor's prescription.

Nicotinamide

Indications for the use of nicotinamide are hypovitaminosis and vitamin deficiency PP, as well as states of increased body need for vitamin PP:

• inadequate and unbalanced nutrition (including parenteral);
• malabsorption, including due to impaired pancreatic function;
• rapid weight loss;
• diabetes;
• prolonged fever;
• gastrectomy;
• Hartnup's disease;
• diseases of the hepatobiliary region - acute and chronic hepatitis, cirrhosis;
• hyperthyroidism;
• chronic infections;
• diseases of the gastrointestinal tract - hypo- and anacid gastritis, enterocolitis, colitis, celiac enteropathy, persistent diarrhea, tropical sprue;
• malignant tumors;
• diseases of the oropharyngeal region;
• prolonged stress;
• pregnancy (especially with nicotine and drug addiction, multiple pregnancy);
• lactation period.

Nicotinamide is not used as a vasodilator. Nicotinamide does not have a lipid-lowering effect.

Due to the neutral reaction of the solution, nicotinamide does not cause local reaction with injections. Unlike nicotinic acid, the drug does not have a pronounced vasodilator effect, therefore, when using nicotinamide, the phenomenon of inflammation is not observed.

The drug is prescribed orally and by injection.

Nicotinic acid for hair

When applied to the scalp, nicotinic acid dilates peripheral blood vessels, increasing blood circulation, improving oxygen transport and useful microelements, enhances metabolic processes in tissues, which prevents hair loss and stimulates their accelerated growth.

The instructions for using the hair solution indicate that when using nicotinic acid, the product stops baldness, the hair becomes thicker, acquires shine and silkiness. Nicotinic acid also supports normal hair pigmentation, being prophylactic against gray hair.
Nicotinic acid included in the product with regular use:

• awakens the sleeping ones hair follicles and promotes hair growth by stimulating microcirculation;
• restores and regenerates damaged bulbs;
• prevents hair loss by strengthening the roots and counteracting the compaction of collagen around the hair root;
• promotes the production of melanin - a pigment that makes curls shiny, preserves their color, and prevents premature graying.

The drug does not dry out the skin after repeated use, which has been proven by dermatological tests.

Method of using nicotinic acid: open the dropper tube immediately before use. Apply the contents of the tube directly after washing to the scalp, evenly distributing the acid over the entire surface with massaging movements. Do not wash off the applied product.

Slight tingling and redness of the scalp after applying the product is due to increased microcirculation and is normal.

Use nicotinic acid once every 3 days. The recommended course is 14 procedures. It can be repeated once every three months.

Despite all the advantages, wide application nicotinic acid has not been found in clinical practice. This is due to the many side effects that accompany taking vitamin PP in high doses.

Nicotinic acid is a vitamin preparation that compensates for the lack of vitamin PP in the body. Available in the form of tablets and solution for injection.

Pharmacological action of Nicotinic acid

According to the instructions, the active component of the product in all forms of release is nicotinic acid.

When used, Nicotinic acid has hypocholesterolemic, hypolipidemic and vasodilating effects. The substance is part of NADP (nicotinamide adenine dinucleotide phosphate) and NAD (nicotinamide adenine dinucleotide), which play an important role in the normal and complete functioning of the body. NAD and NADP are compounds that carry out redox processes, carbohydrate metabolism, tissue respiration, glycogen breakdown and regulation of lipid and protein synthesis. NADP is involved in phosphate transport.

Nicotinic acid prevents the development of pellagra, which may be caused by a lack of vitamin PP in the blood.

When used, Nicotinic acid has a short-term vasodilating effect, improves microcirculation, enhances the fibrinolytic activity of the blood, which leads to a decrease in platelet aggregation.

The drug blunts lipolysis in adipose tissue and reduces the rate of synthesis of lipoproteins, which have a reduced density. Under the influence of Nicotinic acid, the lipid composition of the blood is normalized, namely: the level of cholesterol and triglycerides decreases, and the content of high-density lipoproteins increases.

Nicotinic acid has the ability to penetrate into breast milk. It is well absorbed in the upper parts of the duodenum and the pyloric part of the stomach. It is biotransformed in the liver and excreted unchanged from the body through the kidneys.

Indications for use of Nicotinic acid

Nicotinic acid is prescribed for the treatment and prevention of pellagra, heart disease, mild forms of diabetes mellitus, peptic ulcers of the gastrointestinal tract, enterocolitis, liver, and gastritis accompanied by low acidity.

The drug is effective in eliminating spasms of the kidneys, arms, legs and brain.

Nicotinic acid is prescribed for hair, as it helps accelerate hair growth.

The vitamin remedy is included in the complex therapy of various infections, atherosclerosis and neuritis of the facial nerve.

Methods of using Nicotinic acid and dosage

For the treatment of pellagra, adults are prescribed 100 mg of nicotinic acid in tablets, taken 4 times a day. Course duration is 1-2 weeks. Children should take 5-50 mg 2-3 times a day. Nicotinic acid injections are also recommended intravenously at 50 mg of the drug or intramuscular at 100 mg 1-2 times a day.

For ischemic stroke, nicotinic acid injections are prescribed intravenously at 10-50 mg.

For other diseases, the vitamin should be taken orally. Adults: 20-50 mg, children: 12.5-25 mg of the drug. Frequency of administration – 2-3 times a day.

To accelerate hair growth, nicotinic acid should be applied to dry, clean scalp daily for 1 month.

For weight loss, it is recommended to take nicotinic acid in tablets at 100-250 mg per day.

Side effects of Nicotinic acid

Nicotinic acid can cause redness of the torso, facial skin, numbness of the limbs, rash, hot flashes, and dizziness.

With rapid intravenous administration of the vitamin, a sharp decrease in blood pressure is possible.

Contraindications for use

Nicotinic acid is not prescribed to people with hypertension, hypersensitivity, gout, during pregnancy and lactation.

Overdose

According to reviews, an overdose of Nicotinic acid is unlikely (due to the low toxicity of the vitamin). Symptoms of overdose are loss of consciousness, hypotension, headaches, dizziness.

Additional Information

Long-term use of acid can lead to the development of fatty liver.

During therapy with Nicotinic acid, regular monitoring of liver function is necessary.

The vitamin preparation must be stored in a dry, dark place out of reach of children.

From pharmacies Nicotinic acid is dispensed without a prescription from your doctor.

Shelf life – 5 years.

pharmachologic effect

Vitamin and lipid-lowering agent. In the body, nicotinic acid is converted into nicotinamide, which binds to coenzymes codehydrogenase I and II (NAD and NADP), which transport hydrogen, and participates in the metabolism of fats, proteins, amino acids, purines, tissue respiration, glycogenolysis, and synthetic processes. Replenishes deficiency of PP (vitamin B 3), is a specific antipellagric agent (vitaminosis of vitamin PP). Normalizes the concentration of blood lipoproteins; in high doses (orally 3-4 g/day) reduces the concentration of total cholesterol, LDL, TG, reduces the cholesterol/phospholipid index, increases the content of HDL, which has an antiatherogenic effect. It has a vasodilating effect at the level of small vessels (including the brain), improves microcirculation, and has a weak anticoagulant effect (increases the fibrinolytic activity of the blood).

The hypocholesterolemic effect is observed within a few days, and a decrease in TG is observed within a few hours after administration.

Indications

Hypo- and avitaminosis RR: pellagra, inadequate and unbalanced nutrition (including parenteral), malabsorption syndrome (including against the background of impaired pancreatic function), rapid weight loss, gastrectomy, Hartnup disease (hereditary disease accompanied by impaired absorption of certain amino acids, including tryptophan), gastrointestinal diseases (gluten enteropathy, persistent diarrhea, tropical sprue, etc.).

Conditions of increased body need for vitamin PP: prolonged fever, diseases of the hepatobiliary region (acute and chronic hepatitis, cirrhosis of the liver), hyperthyroidism, chronic infections, malignant tumors, prolonged stress, pregnancy (especially against the background of nicotine and drug addiction, multiple pregnancy), period lactation.

Hyperlipidemia, incl. primary hyperlipidemia (types IIa, IIb, III, IV, V).

Ischemic cerebrovascular accidents, obliterating vascular diseases of the extremities (obliterating endarteritis, Raynaud's disease), vascular spasm of the extremities, biliary and urinary tracts; diabetic polyneuropathy, microangiopathy.

Neuritis of the facial nerve, hypoacid gastritis, enterocolitis, colitis, long-term non-healing wounds and trophic ulcers.

Contraindications

Hypersensitivity to nicotinic acid.

For oral administration: peptic ulcer of the stomach and duodenum in the acute phase, children under 2 years of age (as a lipid-lowering agent).

For parenteral use: severe arterial hypertension, atherosclerosis, gout, hyperuricemia, childhood.

Dosage

To prevent pellagra for adults, 15-25 mg/day orally, for children - 5-20 mg/day. For pellagra in adults, 100 mg orally 2-4 times a day for 15-20 days, parenterally - 10 mg 1-2 times a day for 10-15 days. Children orally - 5-50 mg 2-3 times a day. For other indications, adults: 20-50 mg (up to 100 mg), children: 5-30 mg 2-3 times a day. For ischemic stroke, 10 mg is administered intravenously.

Side effects

From the cardiovascular system: hyperemia of the skin of the face and upper half of the body with a feeling of tingling and burning; with rapid administration - a decrease in blood pressure, orthostatic hypotension, collapse.

From the central nervous system and peripheral nervous system: paresthesia, dizziness.

From the digestive system: with long-term use - fatty liver degeneration.

From the side of metabolism: with long-term use - hyperuricemia, decreased tolerance to, increased blood levels of AST, LDH, alkaline phosphatase.

Local reactions: pain at the site of subcutaneous and intramuscular injections.

Others: allergic reactions.

Drug interactions

Caution must be exercised when combined with antihypertensive drugs, anticoagulants, etc.

Nicotinic acid reduces the toxicity of neomycin and prevents the decrease in cholesterol and HDL concentrations induced by it.

special instructions

Use orally with caution in patients with hemorrhages, glaucoma, gout, hyperuricemia, liver failure, arterial hypotension, hyperacid gastritis, gastric and duodenal ulcers (in remission).

Use parenterally with caution in patients with hemorrhages, glaucoma, liver failure, arterial hypotension, hyperacid gastritis, gastric and duodenal ulcers (in the acute phase).

During treatment it is necessary to monitor liver function.

It is not advisable to use for the correction of dyslipidemia in patients with diabetes mellitus.

To prevent liver complications, it is recommended to include foods rich in methionine (cottage cheese) in the diet or use methionine and other lipotropic agents.

Use in childhood

Contraindications:

— for oral administration: children under 2 years of age (as a lipid-lowering agent).

— for parenteral use: children's age.

For liver dysfunction

Use with caution in patients with liver failure.

With long-term use of nicotinic acid in high doses, fatty infiltration of the liver may develop.

During treatment it is necessary to monitor liver function. To prevent complications from the liver, it is recommended to include rich foods (cottage cheese) in the diet or use methionine, lipoic acid and other lipotropic agents.